Abstract
The purpose of this study was to evaluate change in the portal systemic pressure gradient (PSPG) following balloon-occluded retrograde transvenous obliteration (BRTO) and the aggravation of esophageal varices. The PSPG was monitored before and after BRTO in 19 patients. PSPG changes were obtained by subtracting the PSPG before BRTO from that after BRTO. The development of outflow vessels (e.g., left inferior phrenic vein) was classified into two grades: Grade 1, BRTO alone; and Grade 2, coil embolization plus BRTO. After confirming demonstration of the whole gastric varices on angiography and computed tomography, BRTO was conducted using a 5% ethanolamine-iopamidol mixture. Endoscopy was performed to evaluate gastric and esophageal varices before, within 1 month, and 3–6 months after BRTO. Eradication of gastric varices was obtained in all patients and aggravation of esophageal varices was seen in 11 patients. The PSPG was significantly elevated by BRTO (p = 0.0362). The PSPG was significantly elevated in patients with Grade 2 compared with those with Grade 1 (7.7 ± 3.7 vs. 3.3 ± 4.3 mmHg, respectively; p = 0.0314) and in those with esophageal varices before treatment compared with those without (7.4 ± 4.0 vs. 3.2 ± 3.9 mmHg, respectively; p = 0.0482). The cumulative aggravation rate of esophageal varices was significantly higher in 11 patients with a PSPG elevation >5 mmHg than in 8 patients with one of ≤5 mmHg (p = 0.0105). In conclusion, BRTO induced a significant elevation in PSPG, with the degree of elevation influencing the aggravation of esophageal varices following BRTO.
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References
Kanagawa H, Mima S, Kouyama H et al (1991) A successfully treated case of fundic varices by retrograde transvenous obliteration with balloon. Jpn J Gastroenterol 88:1459–1462
Kanagawa H, Mima H, Kouyama H et al (1996) Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 11:51–58
Koito K, Namieno T, Nagakawa T et al (1996) Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol 167:1317–1320
Hirota S, Matsumoto S, Tomita M et al (1999) Retrograde transvenous obliteration of gastric varices. Radiology 211:349–356
Fukuda T, Hirota S, Sugimura K (2001) Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and encephalopathy. J Vasc Interv Radiol 12:327–336
Takuma Y, Nouso K, Makino Y et al (2005) Prophylactic balloon-occluded retrograde transvenous obliteration for gastric varices in compensated cirrhosis. Clin Gastroenterol Hepatol 3:1245–1252
Ninoi T, Nishida N, Kaminou T et al (2005) Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol 184:1340–1346
Kitamoto M, Imamura M, Kamada K et al (2002) Balloon-occluded retrograde transvenous obliteration of gastric fundal varices with hemorrhage. AJR Am J Roentgenol 178:1167–1174
Arai H, Abe T, Shimoda R et al (2005) Emergency balloon-occluded retrograde transvenous obliteration for gastric varices. J Gastroenterol 40:964–971
Shiba M, Higuchi K, Nakamura K et al (2002) Efficacy and safety of balloon-occluded endoscopic injection sclerotherapy as a prophylactic treatment for high-risk gastric fundal varices: a prospective, randomized, comparative clinical trial. Gastrointest Endosc 56:522–528
Matsumoto A, Hamamoto N, Nomura T et al (1999) Balloon-occluded retrograde transvenous obliteration for high-risk gastric fundal varices. Am J Gastroenterol 94:643–649
Nakamura S, Torii N, Yatsuji S et al (2008) Long-term follow up of esophageal varices after balloon-occluded retrograde transvenous obliteration for gastric varices. Hepatol Res 38:340–347
Hiraga N, Aikata H, Takaki S et al (2007) The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 42:663–672
Groszmann RJ, Glickman M, Blei AT et al (1979) Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology 76:253–258
Miyamoto Y, Oho K, Kumamoto M et al (2003) Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol 18:842–934
Akahane T, Iwasaki T, Kobayashi N et al (1997) Changes in liver function parameter after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol 92:1026–1030
Ninoi T, Nakamura K, Kaminou T et al (2004) TIPS versus transcatheter sclerotherapy for gastric varices. AJR Am J Roentgenol 183:369–376
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Tanihata, H., Minamiguchi, H., Sato, M. et al. Changes in Portal Systemic Pressure Gradient After Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices and Aggravation of Esophageal Varices. Cardiovasc Intervent Radiol 32, 1209–1216 (2009). https://doi.org/10.1007/s00270-009-9679-3
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DOI: https://doi.org/10.1007/s00270-009-9679-3